US drug policy at the UN. Is the glass becoming more than half full?

Here's the good news: From what I'm seeing here on the ground here at the 53rd annual
UN global drug policy meeting in Vienna, the public face of US drug policy has changed overall under the new administration -- and for the better. There's a more humane, compassionate message, plus a greater understanding of both drugs and drug users. Only time will tell where this will lead, but it's a start. And a very welcome one, too.

Because -- and not to mince words -- US drug policy has historically been punitive, impervious, murderous, and devastating. Not least because of the enormous power the US exercises publicly and behind the scenes. I've seen that power in action during previous CND meetings, watching as proxy states doing the bidding of the US raise objections to progressive developments in global drug policy. And I've spent my entire professional life (such as it is) criticizing it and being badgered by it.

Still, even at its worst, I've always respected the way the US prepares for these meetings. They bring a large, smart, well-prepared team of career diplomats and policy analysts, plus some treatment/science-based folks. Not too dissimilar to the advocates that show up, really, except we don't have much money or much power beyond our passion and experience.

But back to my original point -- that things appear to be changing over the last couple of years as far as the US message is concerned and there may be cause for hope.

Exhibit A: Gil Kerlikowske, who just took over as US Drug Czar last May (official title: Director of the Office of National Drug Control Policy, or ONDCP). His smooth opening remarks for the US delegation this past Monday emphasized evidence-based interventions such as Screening, Brief Intervention, and Referral to Treatment, or SBIRT (a harm reduction intervention in many ways) and drug courts, but also advocated integrating addiction medicine into more mainstream medical settings. Kerlikowske also talked up a 17% increase in the federal budget for demand reduction enhancement. That means devoting more money to dealing with domestic drug problems. (Alas, apparently the written version of his remarks is explicit about the US not being comfortable with the term "harm reduction," so that battle that dominated last year's meeting, which I've documented in numerousposts, is far from over.)

Exhibit B: Kerlikowske's second in command, ONDCP Deputy Director Tom McLellan, who has held his post since last August. As the meeting progressed to the more substantive "thematic" debate, his remarks during his presentation at the podium and from the floor were reasonable, pragmatic, and targeted. McLellan explicitly recognized that not all use is problematic and that there are degrees of drug use and drug problems. Chaotic drug problems lie in the top pinnacle of a pyramid of drug use, the larger portion of which is those Americans who do not use drugs. He also acknowledged later that problematic drug use is not necessarily a permanent condition and that he felt remiss in not saying so publicly. Oh brave new world!

In welcome contrast to the bellicose rhetoric that the US delegation usually propagates, McLellan spoke of addiction as a disease. I would have liked to hear him add that not all drug use is an illness and that there is a genuine spectrum. But believe me, it's a great day when the ONDCP moves from the War on Drugs paradigm of criminalization and mass incarceration to the public health model.

While McLellan didn't detail the ONDCP's new direction in great depth, he did talk about moving away from mass social marketing campaigns to a more nuanced approach targeting different communities and populations. Smart. Regarding young drug users and youth, he acknowledged that it's not about drugs in and of themselves but about the "other" issues in young people' lives as they grow and develop. (Not rocket science, I know, but still not the kind of thing we've been hearing from the ONDCP in the past.)

McLellan offered genetics and brain disease as proof of the existence of the "disease" of addiction. But let's face it. Most drug users that use social services operating on a harm reduction model (such as syringe exchange programs) do not need to beaten over the head about the role drug use plays in their lives. They can be extremely articulate about the consequences of their own drug problems and what the solutions are but they're never asked, consulted or considered active participants in the solution.

Is this kind of change in tune (and performer) that Kerlikowske and McLellan represent comprehensive from a progressive drug advocate's point of view? Absolutely not, especially given the US government's schizophrenic fear of harm reduction. Still, in the broader world of how problematic drug use is addressed in the US, it does signify a positive direction.

It's obviously early days, so I'm reserving further judgment until I see change on the ground and the discarding of our old and imperfect ways. (In the ideal scenario, we start talking about releasing our drug users from prison and getting them back their freedom and families, too.) Again, it's a welcome start.